Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection

BACKGROUND

A decrease in risk of urinary-tract infection is one of the most commonly given reasons for circumcision of newborn boys. Previous studies have reported rates of UTI to be 10-20 times higher in uncircumcised than in circumcised boys. This population-based cohort study followed neonates in Ontario, Canada, prospectively to study the relation between circumcision and subsequent UTI risk.

METHODS

Eligible boys were born to residents of Ontario between April 1, 1993, and March 31, 1994. We used hospital discharge data to follow up boys until March 31, 1996.

FINDINGS

Of 69,100 eligible boys, 30,105 (43.6%) were circumcised and 38,995 (56.4%) uncircumcised. 888 boys circumcised after the first month of life were excluded. 29,217 uncircumcised boys were matched to the remaining circumcised boys by date of birth. The 1-year probabilities of hospital admission for UTI were 1.88 per 1000 person-years of observation (83 cases up to end of follow-up) in the circumcised cohort and 7.02 per 1000 person-years (247 cases up to end of follow-up) in the uncircumcised cohort (p<0.0001). The estimated relative risk of admission for UTI by first-year follow-up indicated a significantly higher risk for uncircumcised boys than for circumcised boys (3.7 [2.8-4.9]). 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life.

INTERPRETATION

Although our findings support the notion that circumcision may protect boys from UTI, the magnitude of this effect may be less than previously estimated.

The generation of human dendritic and NK cells from hemopoietic progenitors induced by interleukin-15

Interleukin-15 (IL-15) is a pleiotropic cytokine that induces the generation and differentiation of lymphoid cells and shares many biological activities with IL-2. We have shown here the development of dendritic cells (DC) from human CD34+ hemopoietic precursor cells cultured for 2-4 weeks with IL-15 alone. DC generated with IL-15 have typical morphological, immunocytochemical, phenotypic, and functional characteristics of mature DC. Dual flow cytometry analysis performed weekly demonstrated increasing co-expression of CD1a or CD83 with HLA-DR, CD80, CD86, IL-2R alpha, beta, and gamma. Two populations of cells were distinguished among CD34+ progeny. Small and medium-size cells were mainly natural killer (NK) cells (72.6-85.2% CD56+) and low numbers of DC (9.1-21.3% CD1a+). Large cells were mostly DC (75.4-95.4% CD1a+). Isolated CD34+ cells did not express IL-2R subunits but after 2-3 days in culture with IL-15, they were found to express IL-2Rgamma. Induced expression of IL-2Rgamma on CD34+ cells may explain the primary mechanism of IL-15-regulated differentiation of hemopoietic precursor cells. Thus, our data suggest that IL-15 stimulates CD34+ cells to differentiate into NK and DC and may represent a new growth and survival factor for lymphoid DC.

Apheresis in grade 4 bone marrow transplant associated thrombotic microangiopathy: a case series

Bone marrow transplant-associated thrombotic microangiopathy (BMT-TM) ranges in severity from a self-limited to a fatal disorder. There has been no specific therapy for this condition. We have previously described a clinical grading system for BMT-TM, based upon lactate dehydrogenase level (LDH) and percentage fragmented cells (FC) as follows: grade 0, normal or increases LDH and % FC < or = to 1.2%; grade 1, normal LDH and FC > or = to 1.3%; grade 2, increases LDH and FC = 1.3-4.8%; grade 3, increases LDH and FC = 4.9-9.6%; and grade 4, increases LDH and FC > or = to 9.7%. Patients with grade 4 BMT-TM usually have fulminant disease and generally succumb. This study summarizes results using a variety of apheresis procedures in a series of 16 patients with grade 4 BMT-TM. The apheresis procedures consisted of plasma exchange (with replacement with fresh frozen plasma or cryo-poor plasma), and protein A immunoadsorption (PAI). The PAI exchanges were not done concurrently with plasma exchange procedures. Fifteen patients had undergone an allogeneic BMT and the 16th patient had undergone an autologous peripheral blood stem cell transplant. Half showed hematologic improvement with a downstaging of their TM to grades 1-3. All non-responders died a median of 11 days following the onset of grade 4 BMT-TM. The median survival in the responders was significantly (P = 0.001) increased to 218 days with three responders surviving more than 400 days following the onset of this severe complication. These results suggest a role for apheresis in the treatment of this lethal complication. Nevertheless grade 4 BMT-TM represents a major complication of BMT; the median survival in this group of 16 patients with grade 4 BMT-TM was only 31 days.

A cluster analysis of the effects of storage mites as allergens in relation to certain occupations and living conditions

The method of cluster analysis was used to examine the data of Wraith, Cunnington & Seymour (1979) to assess the role and allergenic importance of storage mites in house dust and other environments in relation to certain factors thought to influence patients' exposure to these species. The analysis provided strong statistical evidence that (a) excessively damp housing and (b) occupational risks of exposure were the two main factors associated with allergy to these species. It also indicated that sensitivity to D. pteronyssinus remained unaltered in environmental conditions more favourable to the growth and development of storage mites. Furthermore, it was shown that the storage species form a group of similar allergens distinct from the house-dust mite.

The t-unique coding domain is important to the transformation maintenance function of the simian virus 40 small t antigen

The small t antigen (t) of simian virus 40, a 174-amino-acid-containing protein, when present together with the other early viral protein, large T antigen (T), plays an important role in the maintenance of simian virus 40-induced neoplastic phenotype in certain cells. Indeed, each protein functions in a complementary manner in this process. The t coding unit is composed of two segments, a 5' region of 246 nucleotides which is identical to that of the corresponding 5' region of the T coding unit and a 3' segment of 276 nucleotides which is unique. Two mutant, t-encoding genomes, one bearing a missense and the other a nonsense mutation at the same point in the t-unique coding region were constructed in vitro and found to be defective in their ability to dissolve the actin cytoskeleton of rat fibroblasts and to complement T in the growth of mouse fibroblasts in soft agar. Therefore, the unique segment of the t gene encodes a portion of the t molecule which is essential to its transformation maintenance function.

Calpain activity in bone marrow transplant-associated thrombotic thrombocytopenic purpura

The pathophysiology of thrombotic thrombocytopenic purpura (TTP) is not well understood. Recent studies have described a platelet aggregating factor which has been characterized as a calcium-dependent cysteine protease (calpain) in patients with TTP. A type of TTP, sometimes called secondary TTP, has been associated with bone marrow transplantation (BMT). However, unlike primary adult TTP, BMT-TTP has important differences and often does not respond well to plasma exchange. We describe the measurement of calpain activity in a group of BMT patients (with and without the clinical syndrome of transplant-associated TTP). Calpain was measured using a functional assay (14C-serotonin platelet release with inhibition by the cysteine protease inhibitor, leupeptin) in the sera of patients following autologous (auto) or allogeneic (allo) BMT. We also independently diagnosed and graded the BMT-TTP on the day of blood sampling using a scale that related to the percentage schistocytes and lactic dehydrogenase level. Calpain activity was detected in 1/8 (13%) grade 0-1 (6 auto, 2 allo); 6/16 (38%) grade 2 (3 auto, 13 allo) 9/16 (56%) grade 3 (2 auto, 14 allo) and 8/8 (100%) grade 4 BMT-TTP. Pre-BMT samples were tested in 10 allo-BMT patients who had positive calpain results post-BMT. One patient gave positive results before the transplant. This patient developed grade 4 BMT-TTP (day 24 post-BMT) and died despite apheresis. Positive calpain results were highly associated with neurologic symptoms, P < 0.001. Nineteen of 24 (79%) patients with positive results had neurologic symptoms compared to three of 21 (14%) patients with negative results. In conclusion, calpain was detected in half of the BMT patients with mild to moderate BMT-TTP (grades 2-3) and was uniformly found in those with severe (grade 4) BMT-TTP. Typically the calpain activity develops as TTP complicates the transplant process. It is unknown whether calpain contributes to the pathogenesis of this disorder, or is a secondary event.

Synergistic Effects of Kaolin and Silicon Nanoparticles for Ameliorating Deficit Irrigation Stress in Maize Plants by Upregulating Antioxidant Defense Systems

Water deficit is a significant environmental stress that has a negative impact on plant growth and yield. In this research, the positive significance of kaolin and SiO₂ nanoparticles in moderating the detrimental effects of water deficit on maize plant growth and yield is investigated. The foliar application of kaolin (3 and 6%) and SiO₂ NPs (1.5 and 3 mM) solutions increased the growth and yield variables of maize plants grown under normal conditions (100% available water) and drought stress conditions (80 and 60% available water (AW)). In addition, plants treated with SiO₂ NPs (3 mM) demonstrated increased levels of important osmolytes, such as proline and phenol, and maintained more of their photosynthetic pigments (net photosynthetic rate (PN), stomatal conductance (gs), intercellular CO₂ concentration (Ci), and transpiration rate (E)) than with other applied treatments under either stress or non-stress conditions. Furthermore, the exogenous foliar application of kaolin and SiO₂ NPs also reduced the amounts of hydroxyl radicals (OH), superoxide anions (O₂), hydrogen peroxide (H₂O₂), and lipid peroxidation in maize plants experiencing a water deficit. In contrast, the treatments led to an increase in the activity of antioxidant enzymes such as peroxidase (POX), ascorbate peroxidase (APX), glutathione peroxidase (GR), catalase (CAT), and superoxide dismutase (SOD). Overall, our findings indicate the beneficial impact of the application of kaolin and silicon NPs, particularly the impact of SiO₂ NPs (3 mM) on managing the negative, harmful impacts of soil water deficit stress in maize plants.

‘Unscrambling’ the drivers of egg production in Agassiz’s desert tortoise: climate and individual attributes predict reproductive output

The ‘bet hedging’ life history strategy of long-lived iteroparous species reduces short-term reproductive output to minimize the risk of reproductive failure over a lifetime. For desert-dwelling ectotherms living in variable and unpredictable environments, reproductive output is further influenced by precipitation and temperature via effects on food availability and limits on activity. We assembled multiple (n = 12) data sets on egg production for the threatened Agassiz’s desert tortoise Gopherus agassizii across its range and used these data to build a range-wide predictive model of annual reproductive output as a function of annual weather variation and individual-level attributes (body size and prior-year reproductive status). Climate variables were more robust predictors of reproductive output than individual-level attributes, with overall reproductive output positively related to prior-year precipitation and an earlier start to the spring activity season, and negatively related to spring temperature extremes (monthly temperature range in March-April). Reproductive output was highest for individuals with larger body sizes that reproduced in the previous year. Expected annual reproductive output from 1990-2018 varied from 2-5 to 6-12 eggs female-1 yr-1 , with a weak decline in expected reproductive output over this time (p = 0.02). Climate-driven environmental variation in expected reproductive output was highly correlated across all 5 Recovery Units for this species (Pearson’s r > 0.9). Overall, our model suggests that climate change could strongly impact the reproductive output of Agassiz’s desert tortoise, and could have a negative population-level effect if precipitation is significantly reduced across the species’ range as predicted under some climate models.

INFLUENCE OF AGING, BEVERAGES, AND MOUTH WASH SOLUTIONS ON THE MICROSTRUCTURAL AND COLOR STABILITY OF DIFFERENT DENTAL CERAMICS: AN IN VITRO STUDY

Рurроse - to evaluate the influence of aging, beverages, and mouthwash solutions on the microstructural and color stability of three CAD/CAM ceramic materials. In total, 87 specimens (7×5×1.5 mm) were prepared from 3 CAD/CAM ceramic groups, Lithium Disilicate glass ceramic (IPS e.max CAD), Extra translucent zirconia (VITA YZ), and Resin Nanoceramic (Cerasmart 270). All the materials were A2 or equivalent shades. After hydrothermal aging in distilled water at 5 C to 55 C for (10.000 cycles). The samples were randomly allocated into 3 groups (n=27) and immersion (staining) for one week in 3 different solutions coffee, green tea, and chlorhexidine. The baseline measurements of ceramic discs were recorded for color change and 2 samples of each group sent for SEM (microstructure) images before aging and staining. The second measurement was recorded after 10000 thermocycling and immersion in staining agents for 7 days. Statistical analysis were performed with an independent Kruskal-wallis test . The significant level was set at P≤0.05. ∆E values for lithium Disilicate after immersion in coffee, green tea and chlorhexidine gluconate were 3.167, 1.847 and 2.022, respectively. corresponding ∆E values for VITA XT were 3.438, 4.201 and 2.267. meanwhile Cerasmart shows more sensitivity for staining than LD and VITA of 4.454, 2.926 and 2.933. Within limitation of this study lithium disilicate showed the best color stability with values less than perception threshold. VITA and Cerasmart show higher sensitivity for staining with VITA more affected by green tea (Higher than clinically accepted threshold) and Cerasmart more affected by coffee (higher than clinically accepted threshold).

Arterial pulsatility as an index of cerebral microangiopathy in diabetes type 2

Transcranial doppler is an inexpensive, non-invasive investigation. This study assessed its validity in determining cerebral small vessel disease in patients with type 2 diabetes mellitus. Flow velocity and pulsatility index were measured in the middle cerebral, basilar and intracranial internal carotid arteries of a sample of 141 diabetic patients with no other risk factors, and 132 age- and sex-matched healthy controls. The patients were divided into 2 groups: 73 with complicated and 68 with uncomplicated diabetes. There was a statistically significant difference between the complicated diabetes and control groups for the 3 arteries and most indices. The differences between the uncomplicated diabetes patients and the controls were also statistically significant but less strongly. Transcranial doppler may be useful in early diagnosis of cerebral small vessel disease in patients with type 2 diabetes mellitus.